| Organization Name: | SPINE & SPORT PHYSICAL THERAPY, PLLC |
| NPI Number: | 1710135546 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KEVIN DAVID FORRER (OWNER, DIRECTOR, PHYSICAL THERAPIST) |
| Mailing Address: | 640 Warrior Dr Suite 115 Stephens City |
| State: | VA US |
| Postal Code: | 226554076 |
| Phone Number: | 5408689599 |
| Fax Number: | |
| NPI Enumeration Date: | 09/04/2008 |
| NPI Last Update Date: | 09/04/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251X0800X |
| License Number: | 2305204141 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Orthopedic |
| Taxonomy Definition: | |